Patient Financial Services Representative II

POSITION SUMMARY:

The Patient Financial Services Representative II (PFSR II) independently manages patient accounts and performs intermediate to advanced revenue cycle functions, including claim correction, denial resolution, appeals, payment posting, charge auditing, and unpaid claim follow-up. This role focuses on resolving accounts, ensuring accuracy, and supporting optimal reimbursement in accordance with established policies and payer requirements.

The PFSR II applies knowledge of coding, coordination of benefits, payer sequencing, and reimbursement guidelines to identify, research, and resolve issues that delay claim submission or payment. Responsibilities include analyzing denials, correcting claim errors, and submitting appeals as appropriate.

The PFSR II is expected to work assigned accounts independently to resolution using available resources, critical thinking, and payer knowledge, collaborating on complex or non-routine issues when necessary. This role provides guidance and shares knowledge with team members as needed during daily operations, without supervisory responsibility.

In addition, the PFSR II recognizes patterns in denials and reimbursement issues, contributing to process improvement discussions and supporting efforts to reduce recurring errors.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work assigned accounts and tasks by applying established workflows, fully working items independently to resolution using available resources and seeking collaboration when necessary for complex or non-routine issues.
• Independently review and manage patient accounts across multiple service areas to ensure accurate billing, payment application, and follow-up.
• Identify, research, and resolve denied and unpaid claims, including correcting claim errors and submitting appeals in a timely manner.
• Analyze payer responses, explanation of benefits (EOBs), and remittance advice to determine appropriate next steps.
• Submit corrected claims and appeals with appropriate documentation to support reimbursement.
• Audit charges, payments, and adjustments to ensure accuracy and compliance with billing standards.
• Post payments, adjustments, and denials accurately while maintaining clear and complete account documentation.
• Perform unpaid claim follow-up, including contacting payers, verifying claim status, and resolving delays.
• Identify trends or recurring issues impacting reimbursement, communicate findings, and contribute to solutions aimed at reducing future occurrences.
• Participate in identifying opportunities to improve billing workflows, claim accuracy, and denial prevention.
• Run, review, and analyze routine and ad hoc reports, including insurance aging, claim holds, unapplied credits, and work-in-progress accounts.
• Ensure compliance with payer guidelines, contractual requirements, and billing regulations.
• Respond to patient and payer inquiries regarding account status, billing details, and financial responsibility.
• Adhere to HIPAA guidelines and organizational policies to ensure confidentiality and security of patient information.

SUPPORTING DUTIES AND RESPONSIBILITIES:

• Provide guidance and share knowledge with PFSR I staff during daily operations.
• Collaborate with team members and other departments to resolve account issues and improve workflows.
• Participate in team meetings, training sessions, and Continuous Quality Improvement (CQI) initiatives.
• Assist with special projects, reporting needs, and data cleanup efforts as assigned.
• Maintain a clean and orderly work area.
• Perform other job-related duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

ANHC's Mission, Vision, and Values: Actively supports ANHC's mission, vision, and values. Includes using individual skills to add value to the mission: To be a trusted partner in every person's wellness by providing integrated, compassionate, and high-quality health care, regardless of ability to pay; and vision: Accessible care for a healthy Anchorage. Aligns actions around organizational values of RESPECT, COMPASSION, PERSONAL INTEGRITY, EXCELLENCE and COLLABORATIVE SPIRIT and gives priority to organizational mission, vision and values when making decisions.

Accountability: Takes ownership for delivering on commitments; owns mistakes and uses them as opportunities for learning and development; openly discusses his/her actions and their consequences both good and bad; has an ability to identify strengths and developmental opportunities and leverages insight to adjust and improve their effectiveness; courage to have difficult conversations.

Adapting to Change: Accepts and adapts to change in a professionally appropriate and thoughtful manner. Is willing to offer a unique perspective or approach and yet knows when and how to stand down graciously and accept a well-thought-out decision. Embraces change.

Confidentiality: Maintains the highest level of confidentiality regarding ANHC records and information relating to ANHC, its customers and employees. Appropriately uses internal confidential information for business purposes only. Responsible for knowledge and compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Communicating Effectively: Shares information. Listens and involves others. Clearly conveys ideas in a manner that engages others and helps them understand and retain the message.

Decision Making/Judgment: Approaches problems and decisions methodically and objectively; involves others as needed; uses sound judgment in making decisions and understanding the impact to themselves, customers, their team, and the organization; conducts the appropriate analysis to identify the symptoms and root cause of issues; makes timely decisions.

Delivering High Quality Work: Makes sure responsibilities central to the role meet all requirements and expectations. Finishes tasks promptly and critically reviews work to ensure quality and accuracy. Considers impact of work to others and takes steps to mitigate. Seeks additional work after finishing tasks.

Demonstrating Initiative: Acts on his/her own without being prompted; handles problems independently; able to resolve issues without relying on extensive help from others; does more than is expected or asked.

Results Orientation: Is focused on outcomes and accomplishments; follows through on commitments; can be counted upon to successfully execute on goals; motivated by achievement and a need for closure; has an attention to detail and is both efficient and effective in achieving a high level of measurable outcomes; persists in achieving goals despite obstacles.

Service Excellence: A desire to consistently provide an exceptional experience to every person. Provides timely and professional service to both internal and external customers; is responsive to customer needs and requests; is always courteous to the customer and considers the needs of the customer when making decisions.

Teamwork: Meets all team deadlines and responsibilities, listens to others and values opinions, helps team and leader to meet goals, welcomes newcomers, and promotes a team atmosphere.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Work Experience: Three to five years of experience in medical billing, patient financial services, or revenue cycle operations, or demonstrated competency in independently managing accounts, resolving denials, and navigating payer requirements.

Education, Certification and Licensure: High school diploma or equivalent required. Medical billing training preferred. Certifications such as CPC, CBC, or other AAPC credentials are preferred but not required

Additional Skills & Knowledge:

• Working knowledge of ICD-10, CPT, HCPCS, NDC, and CDT coding structures and payer-specific billing requirements.
• Strong understanding of coordination of benefits, payer sequencing, and denial management.
• Ability to analyze account activity and resolve discrepancies independently.
• Proficiency in billing systems, Microsoft Office, and ten-key data entry.
• Strong attention to detail, time management, and organizational skills.
• Effective communication and customer service skills.

PHYSICAL, SENSORY, ENVIRONMENTAL QUALIFICATIONS:

The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to remain sedentary for prolonged periods of time at a workstation, which may involve walking and standing for brief periods of time. Occasionally they will exert up to 20 lbs. of force to move objects and files. Must be able to work under pressure to meet deadlines within assigned timeframe. Must be able to work occasional evenings and weekends.

Work is performed in a healthcare clinic and office setting. ANHC is a tobacco-free campus.

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT:

Anchorage Neighborhood Health Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws. Anchorage Neighborhood Health Center complies with applicable state and local laws governing non-discrimination in employment in every location in which the organization has facilities. This policy applies to all terms and conditions of employment, including hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Persons alleging unequal treatment should contact the Chief Human Resources Officer.